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The issues facing all hospitals are myriad and increasingly complex, but for public hospitals that treat a disproportionate share of uninsured, most vulnerable patients and serve as the only safety-net, the challenges are especially daunting, even more so in an emergency department. But the right technologies, resources and creativity can help begin long-overdue changes that are just beginning to take root amid the rapidly evolving world of healthcare.
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That was the main takeaway Monday night from the opening of MedCity ENGAGE, MedCityNews.com’s conference on innovations in patient engagement and healthcare delivery held just outside of Washington, D.C. The evening before the ENGAGE kicked off with a gala hosted by ShareWIK. Attendees – a mix of patients, physicians, health insurance executives and policymakers – got a red-carpet style welcome and viewed “Code Black,” an award-winning independent documentary that follows emergency medicine residents at Los Angeles County Hospital.
The film and offers a harsh and sobering glimpse of emergency medicine at its rawest form and confronts issues like maintaining patient dignity, designing an ER with patients in mind and battling an increasingly complicated healthcare bureaucracy. It was picked as the perfect segue to the two days of discussions that make up ENGAGE.
The film was followed by a four-member panel that included emergency room physicians and healthcare technologists (moderated by Politico’s Ashley Gold). One thing that resonated with the panel – and a major theme of the documentary – was the level of documentation carried out by clinicians, much of it dictated by regulations on patient privacy and out of fear of litigation. Both are ongoing issues in healthcare, particularly as more EHRs are adopted. The burden of the paper work or constant updating to a computer ultimately takes time away from the patients, the panel said.
“We really do want to spend more time with patient and we really do want to practice medicine , and there’s a lot of things that get in the way,” said Dr. Mary Jacob, a resident at George Washington University Medical Center.
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Code Black discussion: privacy vs timely care, $ vs open access, innov tech solutions to help w challenges #mcengage pic.twitter.com/Dd89Nj68Ze
— BioMaryland Center (@BioMaryland) September 30, 2014
Particularly in emergency medicine, the constant disruption of documentation needs to be addressed, and sacrificing a bit of patient privacy is likely in order for the sake of efficiency when sick patients are waiting in emergency rooms for 15 hours at a time.
“It’s one of those things – emergencies don’t wait,” Dr, Jacob said. “They happen when they happen.”
But while it’s important to discuss and identify the problems, it’s equally important to talk about solutions, said Dr. Aisha Liferidge, assistant professor and attending physician at the George Washington University Hospital Department of Emergency Medicine.
“It’s a matter of being creative,” she said. “ I think we have to use technology in a little better way to our advantage. To that end, perhaps we should utilize more telemedicine, perhaps start conversations via camera.”
One possible idea, she noted, was the use of mobile devices that can be used to input important information at the patient’s bedside rather than constantly interrupting the work flow.
“Having mobile devices so that every time you need to chart, you don’t have to go back and fourth,” could be one solution, she said. Dr. Jacob nodded in agreement.
Nancy Green, managing principal for Verizon Healthcare, echoed Dr. Jacob’s observation regarding privacy, though all panelists acknowledged the intention of patient privacy is important, yet perhaps over applied in emergencies.
Green also noted that Verizon Healthcare often hears calls for mobile adoption in all healthcare settings , and that the idea is currently being explored.
“We’re trying to work on that,” she said. “Clearly with the mobile side and the log-ins, we hear that all the time. We’re working on those things. It’s really not a healthcare problem, it’s a log-in problem.”
Indeed, Drs. Jacob and Liferidge sympathized with the ER residents in the film, who bemoaned having to input numerous data into equally numerous systems. It turns out ER physicians are human who struggle with remembering passwords like the rest of us.
Much of the excessive documentation occurs because compliance concerns with HIPAA and other regulations, but there is often a lack of understanding on policy from the providers. As a result, the practice is to err on the side of excessive caution for fear of both noncompliance and ligation.
“The disconnect between policy and what we practice is very real,” Dr. Liferidge said.
Chris Seper, MedCity Media’s CEO, noted that much of the attempted technological fixes are in very early stages. As the technology advances, so, too, will issues on policy.
“Technology is forcing the issue on so many topics,” he said. “The issues of policy will be confronted quickly because of technology.”
